TULIP study: Trail of Lurasidone in bipolar disorder in Pakistan.

BACKGROUND: This study examined usefulness and efficiency of Lurasidone in appraisal with the placebo as for the treatment of Bipolar Disorders. METHODS: Seven treatment centers in Pakistan were selected for the purpose of starting a six week-long control trial (randomized and double-blind placebo). 76 subjects, already diagnosed with Bipolar I or II based on DSM 5 diagnosis, were selected after randomization. Patients were allocated in one of the two groups. Primary efficacy of the drug was measured using Young Mania Rating Scale. Positive response of the drug was defined as 50% reduction in symptoms from the baseline/13 point less than the baseline score on Young Mania Rating Scale. Efficacy and safety of the drug was assessed using variety of markers such as administering extra-pyramidal symptoms rating scale, adverse side effects reported, electrocardiograms, body weight, vital signs changes, and laboratory investigations. RESULTS: Patients treated with Lurasidone showed enhanced improvement in their overall health and symptoms manifestation in comparison to patients who were given placebo. Lurasidone treated patients showed a better response to the drug (66%), in comparison with the placebo treated patients (42%). LIMITATIONS: Study was conducted on small scale due to complexity. CONCLUSION: Patients treated with Lurasidone showed reduction in bipolar symptoms and tolerate the drug well.

Monte Carlo commissioning of radiotherapy LINAC-Introducing an improved methodology.

PURPOSE: Monte Carlo (MC) commissioning of medical linear accelerator (LINAC) is a time-consuming process involving a comparison between measured and simulated cross beam/lateral profiles and percentage depth doses (PDDs) for various field sizes. An agreement between these two data sets is sought by trial and error method while varying the incident electron beam parameters, such as electron beam energy or width, etc. This study aims to improve the efficiency of MC commissioning of a LINAC by assessing the feasibility of using a limited number of simulated PDDs. MATERIALS AND METHODS: Using EGSnrc codes, a Varian Clinac 2100 unit has been commissioned for 6 MV photon beam, and a methodology has been proposed to identify the incident electron beam parameters in a speedier fashion. Impact of voxel size in 3-dimensions and cost functions used for comparison of the measured and simulated data have been investigated along with the role of interpolation. RESULTS: A voxel size of 1 × 1×0.5 cm3 has been identified as suitable for accurate and fast commissioning of the LIANC. The optimum number of simulated PDDs (required for further interpolation) has been found to be five. CONCLUSION: The present study suggests that PDDs alone at times can be insufficient for an unambiguous commissioning process and should be supported by including the lateral beam profiles in the process.

Frequency of Depressive Disorders among Women after Miscarriage.

OBJECTIVE: To ascertain the frequency of depressive disorder in women after miscarriage. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: The Outdoor Department of Gynaecology and Obstetrics, Services Hospital, Lahore, from January to June 2017. METHODOLOGY: A total of 150 women from Outdoor Department of Gynecology and Obstetrics, Services Hospital, Lahore, fulfilling the inclusion criteria, were registered. Clinical assessment and the diagnosis for depressive disorder was performed by psychiatrist by putting criteria given in International Classification of Disease: 10th Revision (ICD-10). ICD 10 criteria require at least 2 symptoms out of three core symptoms (depressed mood, loss of interest, and reduced energy) along with at least 2 other symptoms, to be diagnosed as depression (ICD 10 criteria is given in annexure 2 of our article as well). The whole data was analyzed on SPSS-10 and p-value was measured. Chi-square was the test of significance. RESULTS: The 150 cases, 62% (n=93) were in age of 15-30 years while 38% (n=57) were in age of 31-40 years, with mean of 29.17 +5.94 years, frequency of depressive disorder among women after miscarriage was recorded in 15.33 (n=23). Stratification for frequency of depressive disorder among women after miscarriage with relation to family history shows that 10 out of 57 cases had family history, while 13 out of 93 cases had no family history of depression (p=0.55). CONCLUSION: The frequency of depressive disorder was not very high among women after miscarriage; however, by taking appropriate interventions like guiding the family members, including friends, to provide emotional support to the women after miscarriage, it may further reduce.